title: Outcome of risk-reducing salpingo-oophorectomy in BRCA carriers and women of unknown mutation status.
abstract: OBJECTIVE
  To compare surgical outcomes and occult cancer rates at risk-reducing salpingo-oophorectomy in BRCA carriers and high-risk women who had not undergone genetic testing.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Tertiary high-risk familial gynaecological cancer clinic.
  
  
  METHODS
  Women undergoing risk-reducing salpingo-oophorectomy between January 2005 and November 2009.
  
  
  METHODS
  Women at high-risk of ovarian/tubal cancer were identified on the basis of the inclusion criteria for the UK Familial Ovarian Cancer Screening Study. Risk management options discussed with 1456 high-risk women included risk-reducing salpingo-oophorectomy. A strict histopathological protocol with serial slicing was used to assess tubes and ovaries.
  
  
  RESULTS
  In total, 308 high-risk women (191 with unknown mutation status; 117 known BRCA1/BRCA2 carriers) chose risk-reducing surgery; 94.5% of procedures were performed laparoscopically. The surgical complication rate was 3.9% (95% CI 2.0-6.7). Four ovarian and ten tubal occult invasive/in situ cancers were found. The overall occult invasive cancer rate was 5.1% (95% CI 1.9-10.83) in BRCA1/BRCA2 carriers and 1.05% (95% CI 0.13-3.73) in untested women. When tubal in situ cancers were included, the overall rate was 4.55% (95% CI 2.5-7.5). Two untested women with tubal carcinoma in situ were subsequently found to be BRCA carriers. The median ages of BRCA carriers (58 years; IQR 13.4 years) and untested women (49.5 years; IQR 20.6 years) with occult invasive/in situ cancer were not significantly different (P = 0.454).
  
  
  CONCLUSIONS
  Both high-risk women of unknown mutation status and BRCA carriers have a significant (although higher in the latter group) rate of occult invasive/in situ tubal/ovarian cancer, with a similar age distribution at detection. The data has important implications for counselling high-risk women on the likelihood of occult malignancy and perioperative complications at risk-reducing salpingo-oophorectomy. Women with occult disease should be offered genetic testing.
authors.affiliation: Department of Gynaecological Oncology, EGA Institute for Women's Health, UCL, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Manchanda
authors.forename: A
authors.initials: A
authors.lastname: Abdelraheim
authors.forename: M
authors.initials: M
authors.lastname: Johnson
authors.forename: A N
authors.initials: AN
authors.lastname: Rosenthal
authors.forename: E
authors.initials: E
authors.lastname: Benjamin
authors.forename: C
authors.initials: C
authors.lastname: Brunell
authors.forename: M
authors.initials: M
authors.lastname: Burnell
authors.forename: L
authors.initials: L
authors.lastname: Side
authors.forename: S
authors.initials: S
authors.lastname: Gessler
authors.forename: E
authors.initials: E
authors.lastname: Saridogan
authors.forename: D
authors.initials: D
authors.lastname: Oram
authors.forename: I
authors.initials: I
authors.lastname: Jacobs
authors.forename: U
authors.initials: U
authors.lastname: Menon
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000235:genetics; D002278:Carcinoma in Situ / Q000235:genetics / Q000473:pathology / Q000517:prevention & control* / Q000601:surgery; D005185:Fallopian Tube Neoplasms / Q000235:genetics / Q000473:pathology / Q000517:prevention & control* / Q000601:surgery; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D005820:Genetic Testing; D006579:Heterozygote; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008875:Middle Aged; D009154:Mutation; D009361:Neoplasm Invasiveness; D010051:Ovarian Neoplasms / Q000235:genetics / Q000473:pathology / Q000517:prevention & control* / Q000601:surgery; D010052:Ovariectomy; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D058994:Salpingectomy; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor